Hepatitis C virus (HCV) is one of the leading causes of liver-related morbidity and mortality globally, while also being the most reported bloodborne infection in the United States. With the acquisition of HIV and HCV infections sharing common risks for transmission, the incidence of coinfection is not an uncommon finding. Approximately 6.2% of people living with HIV are coinfected with HCV, with the highest rate being observed among people who inject drugs (82.4%), followed by men who have sex with men (MSM) (6.4%) and heterosexually exposed or pregnant individuals (2.4%). When looking at the United States specifically, the CDC estimates approximately 21% of people with HIV are coinfected with HCV, with the highest incidence seen in those who inject drugs, similar to the global data.
Approximately one-third of patients with HCV will have liver disease progress to cirrhosis, with a median time to progression of 20 years. Several risk factors can accelerate the rate of disease progression: older age, male sex assigned at birth, alcohol use, and coinfection with HIV, particularly those with lower CD4 cell counts. In those who develop cirrhosis and are coinfected with HIV, end-stage liver disease and hepatocellular carcinoma occurs at a faster rate compared with those individuals who do not have HIV, regardless of viral suppression status. With the advent of direct-acting antivirals, the morbidity and mortality rate of patients coinfected with HCV and HIV has declined.
Source : Infectious Disease Special Edition
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